Giving Prisoners Addictive Drugs: Sometimes a Good Idea

Methadone therapy can help opiate-addicted inmates recover, and many countries have embraced it. But the U.S. hasn't.


A drug addict receives a cup of methadone at a hospital in Nanjing, China. Sean Yong/Reuters

Considering the high rates of opiate dependency among American prisoners (heroin and OxyContin), short-term jails seem like an ideal place for methadone programs. Several decades' worth of evidence confirm that methadone treatment works. Also well documented is the link between opiate use and crime. According to one National Institutes of Health report, over 95 percent of heroin addicts committed a crime during an 11-year time period. In New York, 12 to 25 percent of arrested felons tested positive for opiate use upon booking in 2003. The NIH says that treating opiate dependence markedly reduces criminal activity.

But precious few correctional facilities have taken the bold step of opening methadone maintenance treatment (MMT) programs, and very few plan to. Why?

One comprehensive study found a cost benefit to taxpayers of $4.00 for every dollar spent on methadone therapy. In other words, drug addicts cost the country more than recovering drug addicts.

The best-known example of an in-prison methadone program is at New York City's Rikers Island Correctional Facility. The facility's Key Extended Entry Program, begun in 1987, offers methadone to addicts charged with misdemeanors and ushers them into a community methadone program upon release (after a prison stay of about 35 days). The Rikers program has led to a significant reduction in criminal recidivism—repeated similar offenses—and a high rate of continued methadone therapy upon release. A few other facilities in the U.S. have similar programs, although some offer methadone only to people who were already in treatment prior to their arrest. In contrast, most prison systems in the European Union offer these sorts of treatments, as do others throughout the world, including some countries with very conservative governments.

A common objection to in-prison methadone programs is that they simply substitute one drug for another. Methadone is a narcotic. "The criminal justice system is very leery of providing psychoactive drugs to inmates," says Stephen Magura, who, as director of The Evaluation Center at Western Michigan University, has conducted several studies of opiate dependency treatments.

But that thinking ignores the very different pharmacologic properties of methadone and other drugs like heroin. When taken on a daily basis, as methadone needs to be, the drug does not cause a high. It's true that sporadic use does confer a high, which has led some inmates to regurgitate their prescribed methadone for sale to other prisoners. But that "hasn't been a widespread issue," says Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, a nonprofit.

The objection also ignores the current assessment of opiate dependence as a medical condition. "In clinical terms, opiate addiction is a chronic disease," says Joanne Csete, of Columbia University's Mailman School for Public Health. "[It's not] a weakness of character, where if only they had the personal strength they wouldn't need methadone."  As Csete and Parrino both explain, withholding methadone from imprisoned addicts is like refusing diabetics insulin. Even if opiate dependency is a self-inflicted disease, Parrino wrote in American Jails Magazine in 2000, a comparison can be made to heart disease resulting from overeating, alcohol consumption, and smoking. "Should the cardiac surgeon deny treatment to these individuals because their cardiac disease is 'self-inflicted' through years of neglecting their own health?"

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Jessica Wapner writes about biomedical issues for Scientific American, Slate, Science, New York, Nature Medicine, Ode, and elsewhere. She also writes Work in Progress for the Public Library of Science's blog network.

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